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FORMS & CHECKLIST No.

KMKI--OHSE-001
Tgl Penerbitan: 10 November 2022
Tgl
“COACHING & COUNSELLING” Persetujuan:
01 Januari 2023

No. Revisi: 01
Divisi: HSE Halaman: 1 dari 1
KMKI Departemen: HEALTH, SAFETY, AND ENVIRONMENT (OHSE)

Hari/Tanggal : Minggu, 12 February 2022


Lokasi : Workshop KMKI

Diberikan oleh :

Nama : F.Tri Endratno Nomor Karyawan :-


Jabatan : Safety Departemen/Perusahaan : Safety KMKI
Tandatangan :

Ditujukan kepada :
Nama : Sugiarto Nomor Karyawan : 22022160
Jabatan : Foreman Electrik Departemen/Perusahaan : Plant
Tandatangan :

Alasan pemberian coaching & Counselling :


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Komentar karyawan penerima coaching & counselling untuk perbaikan :


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Dengan ini saya menyatakan akan melakukan tindakan perbaikan terkait dengan kinerja ataupun pelanggaran agar tidak
terjadi kesalahan ataupun pelanggaran di kemudian hari. Jika ditemukan pelanggaran ataupun kejadian berulang dilain
waktu saya bersedia mendapatkan sangsi atau peringatan sesuai ketentuan.

Hormat Saya,

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